Nasal surgery in children with facial clefts is a subspecialty of facial reconstructive surgery and should be performed by experienced cleft surgeons integrated with a craniofacial center. Our rhinoplasty surgeons are experienced cleft surgeons and are an integral part of the Plastic & Reconstructive section of The New Jersey Institute for Craniofacial Surgery.

 

If a cleft of the lip is complete, it extends into the base of the nose, disrupting the normal anatomy. The result is an unsupported, flat, and asymmetrical appearing nose with obstruction of air flow. A significant improvement in nasal function and aesthetics is made at the time of the initial lip repair with a reorientation of the tissues and nostrils. However, commonly there is a lack of support of the nasal tip that persists into adolescence. If the cleft is bilateral (on both sides), the nasal deformity will tend to be more severe; however, the appearance will be more symmetrical.

 

Corrective nasal surgery can be performed once growth of the upper jaw and midface is completed, around 14 years of age. However, if there is a deficiency of the upper jaw and corrective jaw is anticipated, nasal surgery should be deferred until after jaw surgery. Corrective jaw surgery will change the position and appearance of the nose, and therefore nasal surgery should be planned after the final facial appearance is achieved.

 

Nasal surgery for a clefted nose typically requires cartilage grafts due to the lack of normal cartridge in the nose. In mild cases, cartilage can be taken from the opposite ear. However, in more severe cases, cartilage from the ribs is required to create a strut graft in order to provide adequate support to the nasal tip. Cartilage may be used to augment other areas of the nose as well.

 

Functional corrections will be made at the same time if indicated to help improve nasal breathing. These corrections may involve correcting the septum and/or inferior turbinates to increase the area for air flow into the nose.

 

Unilateral (one side) and bilateral (both sides) clefts present with different nasal deficiencies. The goals for reconstruction of both types remain the same; however, different procedures may be utilized, and different results will be expected.